Classifications

• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
  • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
  • A61F2/02—Prostheses implantable into the body
  • A61F2/30—Joints
  • A61F2/46—Special tools for implanting artificial joints
  • A61F2/4603—Special tools for implanting artificial joints for insertion or extraction of endoprosthetic joints or of accessories thereof
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
  • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
  • A61F2/95—Instruments specially adapted for placement or removal of stents or stent-grafts
  • A61F2/962—Instruments specially adapted for placement or removal of stents or stent-grafts having an outer sleeve
  • A61F2/966—Instruments specially adapted for placement or removal of stents or stent-grafts having an outer sleeve with relative longitudinal movement between outer sleeve and prosthesis, e.g. using a push rod
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
  • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
  • A61F2/01—Filters implantable into blood vessels
  • A61F2/013—Distal protection devices, i.e. devices placed distally in combination with another endovascular procedure, e.g. angioplasty or stenting
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
  • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
  • A61F2/02—Prostheses implantable into the body
  • A61F2/24—Heart valves ; Vascular valves, e.g. venous valves; Heart implants, e.g. passive devices for improving the function of the native valve or the heart muscle; Transmyocardial revascularisation [TMR] devices; Valves implantable in the body
  • A61F2/2427—Devices for manipulating or deploying heart valves during implantation
  • A61F2/243—Deployment by mechanical expansion
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
  • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
  • A61F2/0004—Closure means for urethra or rectum, i.e. anti-incontinence devices or support slings against pelvic prolapse
  • A61F2/0022—Closure means for urethra or rectum, i.e. anti-incontinence devices or support slings against pelvic prolapse placed deep in the body opening
  • A61F2/0027—Closure means for urethra or rectum, i.e. anti-incontinence devices or support slings against pelvic prolapse placed deep in the body opening inflatable
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
  • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
  • A61F2/01—Filters implantable into blood vessels
  • A61F2/011—Instruments for their placement or removal
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
  • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
  • A61F2/02—Prostheses implantable into the body
  • A61F2/04—Hollow or tubular parts of organs, e.g. bladders, tracheae, bronchi or bile ducts
  • A61F2/06—Blood vessels
  • A61F2/07—Stent-grafts
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
  • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
  • A61F2/82—Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
  • A61F2/844—Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents folded prior to deployment
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
  • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
  • A61F2/82—Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
  • A61F2/86—Stents in a form characterised by the wire-like elements; Stents in the form characterised by a net-like or mesh-like structure
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
  • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
  • A61F2/82—Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
  • A61F2/86—Stents in a form characterised by the wire-like elements; Stents in the form characterised by a net-like or mesh-like structure
  • A61F2/90—Stents in a form characterised by the wire-like elements; Stents in the form characterised by a net-like or mesh-like structure characterised by a net-like or mesh-like structure
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
  • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
  • A61F2/95—Instruments specially adapted for placement or removal of stents or stent-grafts
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
  • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
  • A61F2/95—Instruments specially adapted for placement or removal of stents or stent-grafts
  • A61F2/9522—Means for mounting a stent or stent-graft onto or into a placement instrument
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
  • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
  • A61F2/82—Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
  • A61F2002/823—Stents, different from stent-grafts, adapted to cover an aneurysm
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
  • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
  • A61F2/95—Instruments specially adapted for placement or removal of stents or stent-grafts
  • A61F2002/9505—Instruments specially adapted for placement or removal of stents or stent-grafts having retaining means other than an outer sleeve, e.g. male-female connector between stent and instrument
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
  • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
  • A61F2/95—Instruments specially adapted for placement or removal of stents or stent-grafts
  • A61F2/962—Instruments specially adapted for placement or removal of stents or stent-grafts having an outer sleeve
  • A61F2/966—Instruments specially adapted for placement or removal of stents or stent-grafts having an outer sleeve with relative longitudinal movement between outer sleeve and prosthesis, e.g. using a push rod
  • A61F2002/9665—Instruments specially adapted for placement or removal of stents or stent-grafts having an outer sleeve with relative longitudinal movement between outer sleeve and prosthesis, e.g. using a push rod with additional retaining means
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
  • A61M25/00—Catheters; Hollow probes
  • A61M25/0021—Catheters; Hollow probes characterised by the form of the tubing
  • A61M2025/0042—Microcatheters, cannula or the like having outside diameters around 1 mm or less

Definitions

• the invention relates to a device for introducing an implant into blood vessels or hollow organs of the human or animal body, comprising an implant, an insertion wire and a detachment tube, wherein the implant is deformable in such a way that it assumes a reduced diameter shape in a microcatheter and expands at the site of implantation after elimination of the external constraint by the microcatheter to adapt to the diameter of the blood vessel or hollow organ, wherein the insertion wire, a holding element is arranged.
• the invention relates to a device for introducing an implant into blood vessels or hollow organs of the human or animal body, comprising an implant and a detachment tube, wherein the implant is deformable in such a way that it assumes a reduced diameter shape in a microcatheter and expands at the site of implantation after elimination of external constraint by the microcatheter to adapt to the diameter of the blood vessel or hollow organ, and the detachment tube has a lumen extending in the longitudinal direction of the device, through which an insertion wire is longitudinally displaceable feasible.
• Arteriovenous malformations in a patient can lead to significant impairments and threats, including death. This is especially true for arteriovenous fistulas and aneurysms, especially if they occur in the cerebral area.
• arteriovenous fistulas and aneurysms especially if they occur in the cerebral area.
• implants are usually placed on the endovascular route with the help of catheters.
• the implantation of platinum spirals has proved successful, which fill the aneurysm more or less completely, largely block the influx of blood and lead to the formation of a local thrombus, which ultimately occludes the aneurysm.
• this treatment method is only suitable for aneurysms that have a relatively narrow access to the vascular system, so-called berry aneurysms.
• the implanted coils may be flushed out again and cause damage in other areas of the vascular system.
• Another disadvantage is the lack of adaptability of the stent to its place of use.
• the stent should attach tightly to the vessel wall without exerting excessive pressure on the wall.
• these stents are to be understood rather as a kind of cuff, which should influence the vascular lumen and the endothelial wall of the vessel as little as possible.
• wire mesh stents have long been known, especially for use in the coronary area. These stents are usually made as a round braid, wherein the individual wire filaments in opposing spiral or helical layers form the stent wall. It creates a mesh that is both supported in the radial direction and permeable to blood.
• Such existing as a round braid of filaments stents are often hydraulically expanded when using for the treatment of stenosis with the help of a balloon at the site and fixed to the vessel wall.
• the balloon attached to an introducer wire serves as a delivery vehicle to which the stent is crimped.
• an implant of advantage which adapts itself to the vessel diameter and applies to the vessel wall of advantage.
• an implant in which the mesh in a microcatheter has a elongated shape with a reduced diameter and expands at the implantation site while adapting to the vessel diameter and increasing the mesh density, wherein the protruding at the implant ends filament ends at least in pairs and connected to each other.
• an implant was provided which is able to adapt to the respective vessel diameter, the filament ends being atraumatic.
• connecting elements are attached to the merged filament ends, which cooperate with holding elements according to the key-lock principle.
• the holding element via which the implant is coupled to an insertion wire, has recesses into which the connecting elements are fitted.
• the connecting elements have a thickening, for example, a spherical shape, so that they are held in a form-fitting manner in the recesses of the holding element.
• the fixation in the recesses can be done by means of a hose which is positively drawn over the retaining element with the fitted connecting elements. This tube is withdrawn proximally after reaching the end position of the implant, and the implant is detached. Subsequently, the insertion wire with holding element, tube and catheter can be withdrawn and removed from the body.
• the described prior art has proven itself in principle, but in some cases it may happen that not all fasteners after retraction of the hose from the provided for them recesses of the holding element solve, for example, because a cant occurs, by a connecting element in the recess the holding element is held. In such a case, the implant does not open as quickly at its proximal end as would be desirable, and may detach from the retaining element only after further movement of the introducer wire. By contrast, it is desirable to have a detachment system in which the implant is completely released from the holding element immediately after retraction of the tube, thereby releasing it. Thus, the object is to further optimize the detachment system on the basis of the prior art described in WO 2008/107172 A1.
• a device for introducing an implant into blood vessels or hollow organs of the human or animal body comprising an implant, an insertion wire and a detachment tube, wherein the implant is deformable in such a way that it Microcatheter assumes a shape of reduced diameter and expands at the site of implantation after elimination of external constraint by the microcatheter to adapt to the diameter of the blood vessel or hollow organ, wherein the insertion a holding element is arranged and the holding element peripherally over at least one, preferably more in the Retaining element has recessed grooves which extend on the circumference of the holding element and form curved-line tracks, wherein the implant at the proximal end at least one, preferably a plurality of proximally extending holding wires, the inserted into the grooves are fitted, wherein the detachment tube is positively tightened over the holding member and the grooves fitted in the retaining wires, so that the retaining wires are held by frictional engagement
• the detachment tube represents a tubular envelope of the grooves of the retaining element and the inserted into the grooves retaining wires.
• the retaining element thus has grooves, which are embedded radially on the outside of the retaining element in the retaining element.
• the grooves are such that proximal extending holding wires can be inserted into the grooves from the implant.
• the retaining wires usually extend beyond the actual implant to the proximal. So that both an advancement of the implant in the direction of distal and a retraction in the proximal direction with the help of the insertion wire is possible, without that the implant separates from the holding element, the grooves have a curved course on the outside of the holding element.
• the dimensions of the grooves and the retaining wires should be coordinated so that the frictional forces between the grooves and the retaining wires, which prevent a solution of the implant, are greater than those occurring during retraction or advancement of the insertion wire tensile or shear forces.
• the cross section of the grooves should be only slightly larger than the cross section of the retaining wires, so that on the one hand after retraction of the detachment tube expanding the implant in the radial direction for the purpose of detachment is easily possible, but on the other hand, the frictional forces between grooves and retaining wires are sufficiently large, so that pulling out the retaining wires can be made from the grooves in the axial direction only with disproportionately high force.
• the definition of the retaining wires in the grooves provided for this purpose is based on friction or force fit.
• the frictional forces between the retaining wires and the grooves are so large that a release by force in the axial direction, ie longitudinal direction of the device or the insertion wire or implant in practice is almost impossible.
• the release tube is withdrawn so far that the grooves are exposed radially, the implant can expand, with the retaining wires simultaneously moving radially outward out of the grooves. In this way, a detachment of the implant from the holding element ensured; the implant is thus finally released and implanted in the space provided for this purpose.
• the insertion wire together with hereby connected holding element, the detachment tube and the microcatheter can be withdrawn and removed from the body.
• the implant is first advanced through the microcatheter to the desired position using the insertion wire.
• the holding element and usually the entire insertion wire is surrounded by the detachment tube.
• the microcatheter is withdrawn first. However, this alone does not cause any final detachment, since the detachment tube continues to ensure that the retaining wires emanating from the implant are held in the grooves of the retaining element.
• the grooves are arranged in the outer region of the holding element;
• proximal refers to the attending physician, ie the proximal end points in the direction of the body exterior. Conversely, distal means the doctor facing away, so the distal end lies in the direction of the body's interior.
• the release tube extends from the support member, the grooves of which must be covered to hold the support wires securely in the grooves, proximally to outside the body. It is also conceivable that the detachment tube does not cover the entire insertion, sufficient is an extension of the detachment tube on the grooves of the support member. The withdrawal of the detachment tube is in this case via a second wire or thread, which runs parallel to the insertion wire from the detachment tube in the proximal direction.
• the grooves may be sinusoidal, for example.
• the grooves extend to form a curved, in particular undulating path on the outside of the holding member from proximal to distal, wherein the grooves do not have to extend over the entire length of the holding member.
• distributed over the circumference of the holding element distributed a plurality of wave-shaped grooves extending from proximal to distal, wherein the wave-shaped grooves are arranged substantially parallel to each other. It is also conceivable that the wave-shaped grooves not only in the longitudinal direction d. H. from proximal to distal, but extend spirally in the longitudinal direction around the holding member.
• the holding element can be made, for example, from stainless steel or a nickel-titanium alloy such as Nitinol.
• the graft itself is typically a mesh of a plurality of braid wires that are spiral or helical in shape, with contra-rotating braid wires intersecting each other to form a mesh.
• braid structures are known in the art
• the implant is a tubular or cut implant in which retaining wires for fitting in the grooves of the retaining element are arranged at the proximal end.
• the proximal portions of the implant forming braid wires.
• individual braid wires may be extended proximally.
• every other, every fourth or every eighth braid wire may be made longer at the proximal end, this extension of the braid wire being proximal to the proximal portion, which is otherwise referred to as a retaining wire.
• This retaining wire is inserted in a groove provided for this purpose.
• every other braided wire can be made longer at the proximal end, so that a total of 32 retaining wires arise and this 32 grooves must be provided in the retaining element. It is also possible to extend only every 4th braid wire lengthened (in the case of 64 braided wires this results in 1 6 retaining wires and 1 6 slots) or every 8 braided wires (in the case of 64 braided wires this results in 8 retaining wires for 8 slots).
• the detachment tube before retraction in the proximal direction for the purpose of releasing the implant covers not only the retaining element and the retaining wires fitted in the grooves, but also the proximal end of the actual implant.
• the release tube thus also covers the shorter proximal ends of the braid wires, which are not extended in the proximal direction for the purpose of forming retaining wires. These proximal ends of the non-lead wires are typically loose, but are also covered by the release tube.
• the advantage of such an embodiment is the fact that even after pushing out of the implant from the microcatheter or withdrawal of the microcatheter, so that the implant is substantially exposed, retraction of the implant in the microcatheter is still possible, as long as the detachment tube, the holding element and covers the fitted in the grooves of the retaining element retaining wires.
• the largest part of the implant can expand radially after retraction of the microcatheter, this does not apply to the proximal end of the implant as long as the detachment tube is slipped over here. If no expansion has taken place at the proximal end of the implant, it is possible to retract the implant into the microcatheter, in which case the already widened regions of the implant again fold tightly together.
• the retaining wires are deformed so that the frictional forces between the retaining wires and the grooves are increased. This additionally improves the fixing of the retaining wires in the grooves and ensures that an unintentional pulling out of the retaining wires from the grooves becomes virtually impossible.
• the retaining wires can be impressed, for example, a two- or three-dimensional shape, which prevents slippage of the retaining wires from the grooves under tensile load. Such imprinting of a two-dimensional or three-dimensional structure can be carried out, for example, by mechanical treatment or heat treatment.
• a simplified release system is also provided, which is based on frictional engagement (adhesion).
• it is a device for introducing an implant into blood vessels or hollow organs of the human or animal body, comprising an implant and a detachment tube, wherein the implant is deformable in such a way that it assumes a reduced diameter shape in a microcatheter and expands at the site of implantation after elimination of external constraint by the microcatheter to conform to the diameter of the blood vessel or hollow organ, and the detachment tube has a lumen extending longitudinally of the device through which an insertion wire is longitudinally displaceable, the detachment tube being proximal Protruding end of the implant and an elastic contact surface between the inside of the implant and the outside of the detachment tube is present, so that a frictional engagement between the implant and the detachment tube is generated, the longitudinal displacement of the Implant within the microcatheter by longitudinal movement of the detachment tube to the dis
• the detachment tube does not enclose the proximal end of the implant or the holding wires emanating from the implant, but protrudes into it.
• a frictional connection between the detachment tube and the implant is made, so that it is possible by advancing or retracting the detachment tube to move the implant in the same way to the distal or proximal.
• the frictional engagement between the detachment tube and the implant is brought about by the part of the detachment tube projecting into the implant at least partially having an elastic contact surface.
• This is preferably an intermediate layer which is present in the part of the detachment tube projecting into the implant on the outside of the detachment tube and can also be referred to as ped.
• the elastic contact surface preferably the intermediate layer, ensures a frictional connection with the implant.
• Such an embodiment is particularly simple in construction and does not require the formation of additional elements which bring about a positive connection.
• the release of the implant takes place in that the implant is pushed out of the microcatheter or the microcatheter is withdrawn proximally relative to the implant. Since the implant has a natural tendency to radially expand after elimination of the external constraint through the microcatheter, the implant dissolves after release from the micro catheter of elastic Päd and attaches to the inner wall of the vessel or hollow organ. The release tube, the microcatheter, and possibly the insertion tube passing through the release tube may then be withdrawn and removed from the body.
• the detachment tube has an inner lumen through which the insertion wire can extend.
• the microcatheter is pushed over the introducer wire to the target site.
• the detachment tube together with the frictionally engaged hereby implant in the direction of distal through the Microcatheter be advanced through.
• the withdrawal and removal of the insertion wire is possible both before, during or after the release of the implant.
• retraction of the insertion wire may occur before or during implant release.
• the elastic contact surface / intermediate layer typically runs annularly or circularly around the detachment tube.
• the release tube is surrounded in a region radially encircling the elastic contact surface / intermediate layer, which ensures the frictional connection with the implant.
• the implant is typically a mesh of braided wires, although other types of implants such as tubular or cut implants are not excluded.
• one or more intermediate layers may be provided, wherein the pads may extend over a certain length within the implant.
• the number of pads will be 1 or 2, wherein in the case of the use of two pads, these may be formed correspondingly shorter.
• the intermediate layers are mounted on the release tube, this has a larger outer diameter than in the adjacent areas without intermediate layer.
• the material used for the liner / pad must be resilient to provide sufficiently high friction forces between the release tube and the implant to permit advancement or retraction of the implant over the release tube without the implant moving longitudinally relative to the release tube or even the release tube solves.
• materials for the elastic intermediate layer many different materials come into question, in particular it can be an elastomer.
• rubber, rubber or silicone can be used.
• the interlayer may also be made of a polymeric material such as polytetrafluoroethylene, polyesters, polyamides, polyurethanes or polyolefins. Particularly preferred are polycarbonate urethanes.
• the intermediate layer is preferably produced by electrospinning.
• fibrils or fibers are deposited from a polymer solution by means of electric current on a substrate. During deposition, the fibrils stick together to form a fleece. In general, the fibrils have a diameter of 100 to 3000 nm. Electrospinning layers are very uniform, tough and mechanically strong.
• an intermediate layer formed integrally with the detachment tube is also encompassed by the term intermediate layer, provided that the intermediate layer is elastic and produces a sufficiently high frictional engagement with the implant.
• the detachment tube has a uniform cross-section in the section extending into the implant, as long as a sufficiently strong frictional engagement between implant and detachment tube is produced.
• a distal portion of the detachment tube may also have a reduced diameter such that this distal portion may be longitudinally inserted into the implant to provide the desired frictional engagement therewith.
• radiopaque material may be provided between the elastic liner and the actual release tube to enhance the visualization of the implant delivery procedure.
• a coil also called coil, made of X-ray-visible material, since this is sufficiently flexible to ensure a smooth feed of the implant.
• radiopaque material in a different form, for example in the form of a plugged onto the detachment tube sleeve.
• radiopaque material are platinum and Platinum alloys preferred.
• the elastic intermediate layer can be provided with a polymer layer, preferably made of polycarbonate urethane, particularly preferably produced by means of electrospinning, as described above.
• a detachment wire in the region in which the detachment tube protrudes into the proximal end of the implant and in which an elastic contact surface between the inside of the implant and the outside of the detachment tube is present is wound around the implant, so that the Stripping wire generates an increase in the frictional forces between the implant and the detachment tube, wherein the stripping wire is formed electrolytically corrodible.
• the implant is not or not exclusively held by the microcatheter in a compressed form, but (also) by a detachment wire, which is wound around the implant and introduced into the implant detachment tube with elastic contact surface.
• the release wire is virtually tied to the implant.
• the detachment hose has elastic contact surfaces, preferably elastic intermediate layers / pads, as described above in order to produce high frictional forces.
• the implant is still held on the release tube with frictional engagement even when the microcatheter has already been withdrawn from the implant or the implant has been pushed out of the microcatheter.
• the detachment wire surrounds the implant in the axial position in which the elastic contact surfaces, preferably the elastic intermediate layers / pads, are located.
• the stripping wire can tie up the implant immediately where there is an elastic contact surface / ped. It is also possible to tie the implant in an axial position of the implant, which lies between two elastic contact surfaces / pads.
• the detaching wire wrapped around the implant is designed to be electrolytically corrodible at at least one detachment point.
• This release point should be in the section of the stripping wire wrapped around the implant in the form of a loop.
• the release point is heated so far that the stripping wire is severed.
• the electrolytic corrosion or the heating is brought about by application to a voltage source.
• the ends of the stripping wire are preferably guided proximally, where the connection can be made.
• the detachment wire extends from proximal to the position of the detachment tube inserted into the implant, where it forms a loop or loop around the implant and runs back again in the proximal direction.
• This detachment point can z. B. have a smaller cross-section than other areas of the stripping wire.
• the materials which can be used for the detachment point correspond to those which are also used, for example, in the case of electrolytically removable implants. These include steel, magnesium or magnesium alloys as well as cobalt-chromium alloys. The latter are described in WO 201 1/147567 A1, to which reference is made in this regard.
• the release wire outside the release point can be completely or partially isolated by a sheath.
• the procedure for introducing the implant is such that the implant fixed to the detachable tube is advanced through the microcatheter to the target site by moving the detachment tube distally.
• the frictional connection between the detachment tube and the implant ensures that the implant moves along with the detachment tube.
• the microcatheter is withdrawn proximally or the implant is pushed distally out of the microcatheter. Due to the strapping by the stripping wire, the implant will continue to be held on the release tube until the attending physician completes the final release of the implant.
• a voltage is applied to the stripping wire, whereupon it is severed and releases the implant for expansion.
• the production of a frictional connection between the implant and the insertion wire also provides, by the way, ie without Presence of the Ablensedrahtes described above, a third embodiment of the invention, which is covered by this application.
• an elastic contact surface in particular in the form of an elastic intermediate layer / an elastic pad is provided on the insertion wire, which increases the frictional forces between the implant and insertion wire so far that a movement of the implant by advancing or retracting the insertion wire is possible.
• the use of the ablation tube described above is dispensable in this case.
• the elastic intermediate layer / elastic pad is preferably made of polycarbonate urethane according to this variant of the invention, in particular by means of electrospinning. This method has already been explained above.
• a coil which is often referred to as a coil in the field of medical technology, be mounted on the insertion wire, wherein the coil with an elastic material is coated.
• elastic materials rubber, rubber or silicone or also polymeric materials such as polytetrafluoroethylene, polyesters, polyamides, polyurethanes or polyolefins. Particularly preferred are polycarbonate urethanes.
• the elastic material thus forms the intermediate layer.
• the coil itself is preferably made of a radiopaque material, preferably platinum or a platinum alloy, thereby allowing visualization of the implantation process.
• the coil is sufficiently bendable, so that the insertion wire with attached implant can also easily follow narrow-lumen blood vessels during advancement. It is also possible in principle to apply X-ray-visible material to the insertion wire in another form, for example in the form of a metallic one Sleeve, however, in this case, the bending softness is lower than in the case of a coil.
• the outer diameter of the detachment tube varies between the proximal and distal ends, wherein the variation of the outer diameter relates to the regions of the detachment tube which do not surround the holding element or lie outside the implant. These last-mentioned areas are referred to below as the distal section.
• the more proximal sections of the release tube should have sufficient resistance to undesirable elongation. This is of particular importance in the proximal section, since this accounts for the largest part of the total length of the detachment tube, the extensibility in the longitudinal direction should therefore be as low as possible, otherwise an undesirably high total elongation can result over the entire length. Also in the distal portion itself, which encloses the retaining element according to the first embodiment of the invention, a greater resistance to undesired elongation may be advantageous for this section of the In fact, when withdrawn, the release tube actually moves proximally rather than stretching only in the longitudinal direction. For this reason, the distal portion may have a larger outer diameter than the middle portion, but this is not absolutely necessary. The desirable outer and inner diameters in the distal portion are also related to the dimensions of the enclosed holding member.
• the u. a. the retaining element surrounds (first embodiment of the invention) or extends into the implant (second embodiment of the invention), a proximal adjoining middle section with a small outer diameter and a proximally connected to the proximal portion proximal portion with a large outer diameter.
• the distal portion has a large outer diameter to enclose the retaining element with the fitted retaining wires.
• the portion which covers the grooves in the retaining element a large outer diameter and thus a greater rigidity than the proximally adjoining thereto middle portion whose flexibility during insertion of the device is of particular importance.
• the proximal section again has a large outer diameter to permit insertion and withdrawal of the release tube over longer distances.
• the length of the middle section is 50 to 500 mm, in particular 80 to 120 mm, particularly preferably about 100 mm.
• the distal portion may, for example, have a length of 2 to 10 mm; this is usually sufficient to cover grooves in the holding element.
• the total length of the release tube may be 1, 000 to 2,000 mm, e.g. Accordingly, the proximal portion is usually the longest and has a length of 500 to 1,900 mm.
• large outer diameter and small outer diameter are to be understood according to the invention that in areas with large Outer diameter of the outer diameter is greater than in areas with a small outer diameter.
• the exact dimensions may vary as well as the ratio of the diameters, in particular depending on the conditions in the blood vessel system and the specific application.
• a typical large outer diameter is in a range of 0.4 to 0.8 mm, in particular 0.5 to 0.7 mm, for example about 0.6 mm.
• a typical small outer diameter is 0.3 to 0.55, in particular 0.4 to 0.5, for example about 0.45 mm.
• the detachment hose is usefully clamped onto the insertion wire, z. B. by means of a Torquers to produce a frictional engagement and to prevent unwanted mutual displacement of insertion and release hose.
• a displacement may take place only when the detachment of the implant is to take place.
• a handle may be provided at the proximal end of the release tube, regardless of the outside diameter in that area. This may be in the form of a thickening or sleeve surrounding the proximal end of the release tube. If the replacement of the implant is to take place, the Torquer, which clamps the detachment tube to the insertion wire, typically solved and possibly reassigned to the insertion to make it easier to handle. The release tube can then be grasped by the user at the handle option and retracted proximally.
• the passage of the implant, along with the introducer wire and surrounding release tube through the catheter, can be facilitated by providing a coating of the release tube on the outside, which reduces the friction between the release tube and the catheter.
• This is preferably a hydrophilic coating.
• a friction-reducing coating on the outside of the insertion or the inside of the release tube can be used.
• PTFE polytetrafluoroethylene
• the detachment tube In addition to the outer diameter and the wall thickness of the detachment tube can vary, d. H. in the areas with large outer diameter, the detachment tube has a higher wall thickness than in the areas with a small outer diameter. The reduction of the wall thickness additionally increases the flexibility and flexibility of the detachment tube, so that within the microcatheter it can follow fine branches of the blood vessel system particularly well.
• the detachable tube can be made by starting from a uniformly constructed detachment tube which has a constant outer and inner diameter, at least over most of the length. H. also has a constant wall thickness. From this detachment hose material is removed outside in the desired sections and thus reduces the outer diameter. Since no material is removed inside, the wall thickness of the detachment tube is reduced to the same extent. One thus obtains a detachment hose, which is in one piece, wherein in partial sections, in particular in the middle section, the outside diameter and the wall thickness have been reduced by material removal. In other sections, z. B. in the proximal and possibly in the distal portion, no material is normally removed, d. H. the original outer diameter is retained here.
• the removal of material can be carried out by means of methods known in principle from the prior art, for. B. by twisting, grinding or peeling with the help of mechanical tools or with the help of a laser. Also at the proximal end material can be removed to allow here to be grasped by a Torquer.
• the release tube is typically made of a plastic. Polyimides have proven particularly useful. However, it is also conceivable to use other materials, for example polypropylene or polytetrafluoroethylene (PTFE). Combinations of various plastics or multilayer coextruded polymers may also be used.
• the release tube can also additionally have a reinforcement by fibers, such as metal fibers are embedded in the release tube. It is conceivable z.
• the detachment tube As a peel tube, which is reinforced by a woven or braided.
• the detachment tube may also be made of metal, wherein the detachment tube should be made thin-walled, so as not to cause excessive bending stiffness.
• nickel-titanium alloys such as nitinol are suitable as metal.
• the above-mentioned materials are applicable to the peel-off hose regardless of whether it is a peel-off hose according to the first or second embodiment of the invention and whether the outside diameter of the peel-off hose varies.
• the detachable tube can have recesses or material dilutions, for example in the form of slots or openings. This applies regardless of which material the release tube is made of, d. H. for both plastics and metals.
• the recesses / material dilutions can be provided especially in certain areas of the detachment tube, in which a low flexural rigidity is of particular importance, for example, be arranged in the distal region, or over the entire length of the detachment tube. The flexibility of the release tube is increased in this way, but without affecting the tensile strength negative.
• the removal of material can be carried out in such a way that the release tube after processing has a variety of different outer diameter.
• the transition from large outer diameter portions to small outer diameter portions and vice versa gradually, for example over several small stages, each having slightly different outer diameters.
• a continuous transition is possible, so that the outer diameter is reduced or increased uniformly.
• the transition is conical.
• the wall of the detachment tube can have a chamfer, an oblique or even a round or curved course at the points of the transition from large to small outer diameter.
• the detachment hose can also be constructed in several parts.
• sections of the detachment tube are connected to each other with different outer diameters, usually cohesively.
• a compound of the sections by gluing.
• the sections When connecting the sections with different outer diameters, the sections should overlap to ensure a secure connection, in particular a sufficient adhesive surface for the bond. Possibly.
• the inner diameter of a larger outer diameter section may be expanded to allow the partial insertion of a smaller diameter section.
• the sections can be chamfered, it is also possible a material removal in other ways. It is also possible to apply a certain additional amount of a suitable mass, for example of the adhesive, in order to obtain in this way a continuous transition from large to small outer diameter.
• the sections may also overlap over longer distances, for example, a layer of the release tube may extend continuously over most of the length of the release tube.
• a layer is possible which begins at the distal end or slightly proximal of the distal end of the detachment tube and extends continuously to the proximal end, thus ensuring a substantially uniform inner diameter of the detachment tube.
• a uniform inner diameter is production technology of advantage.
• an outer layer of the release tube is applied to the continuous layer of the release tube on the outside. The inner and outer layers are joined together, in particular glued.
• a detachment tube of larger outer diameter and higher total wall thickness in the sections where no outer layer is present, on the other hand, the outer diameter and the wall thickness are smaller.
• a multilayer construction also makes the sections of the detachment tube with a large outer diameter, in particular the proximal section, more flexible. Due to the relatively high wall thickness and the associated large cross-sectional area of the outer wall, however, the tensile strength is high. Compared to a single-layer structure of the wall of the detachment tube with a total of the same wall thickness, the flexibility is thus higher, but the tensile strength comparable.
• the transitions between large and small outer diameter portions may be formed continuously or in the form of a plurality of small steps.
• the release tube next inner and outer layer may have further layers, the release tube can therefore be basically constructed of any number of layers.
• the distance between the insertion and the inner wall of the detachment tube is important, as at too great a distance, ie in relation to the inner diameter of the detachment tube to thin insertion during the advance in the micro catheter bending or kinking can take place , which makes the further feed impossible in extreme cases.
• too small a distance from the inner wall of the detachment tube to the insertion wire is problematic in that high relative friction forces occur, which can hinder, for example, the withdrawal of the detachment tube for the purpose of detachment of the implant. It is advantageous if an inner layer of the detachment tube extends at least substantially continuously from distal to proximal.
• the inner layer extends over at least 70%, preferably at least 80% and particularly preferably at least 90% of the length.
• the inner layer is understood to mean not only a layer which is initially present separately and is subsequently connected to an outer layer, but also the inner part of an integrally formed detachment tube, as described above. This not only leads to a uniform inner diameter, but also to the fact that unwanted elongations of the detachment tube are largely avoided during proximal retraction.
• the sections in which flexibility is of particular importance, especially the middle section are particularly thin and flexible, so that the detachment tube can be well guided through narrow blood vessels.
• further sections, in particular the proximal and possibly the distal section are sufficiently resistant to undesired extension of the detachment tube when it is withdrawn proximally. This ensures a safe and easy replacement of the implant.
• the insertion wire may have different diameters in different sections.
• the diameter may be distally smaller than in the proximal portion, since a low bending stiffness is also of advantage for the insertion wire distally so that it can follow the course of the blood vessel as well as possible within the microcatheter.
• too small a diameter can also cause the insertion wire to bend during advancement, making further advancement difficult or impossible. It is therefore useful to provide the insertion wire in the distal portion with a smaller diameter, since the insertion wire is particularly reliant on following the course of the blood vessel, while in the proximal section more the easy feed is in the foreground.
• the diameter can also vary several times over the length of the insertion wire, wherein at the transitions the diameter preferably increases or decreases uniformly.
• the transitions are thus preferably conical.
• the variation of the diameter of the insertion wire can also be independent of the variation of the outer diameter of the release tube.
• a lower diameter in the distal portion of the insertion wire is advantageous, individual regions of the insertion wire can again have a larger diameter in the distal section. This is especially true for the tip of the insertion wire.
• the portions of the small diameter lead-in wire may be filled with a polymer, e.g. As PTFE enveloped. In this way, play between the insertion wire and the detachment tube is avoided, whereby an undesirable deformation of the insertion wire is prevented during the feed.
• the introducer wire remains sufficiently flexible and flexible in this section because the polymer virtually does not stiffen the introducer wire.
• the polymer can also be provided in the form of a helical coil surrounding the insertion wire wholly or in some areas.
• the helical coil can also consist of another material, in particular of metal.
• the outside diameter of the detachment tube and the diameter of the insertion wire increase or decrease approximately synchronously with one another. This is also useful insofar as high flexibility is desirable in the same sections of detachment tube on the one hand and insertion wire on the other hand. In addition, it is ensured in this way that the distance between the inner wall of the detachment tube and insertion wire remains relatively constant.
• the diameter of the lead-in wire can decrease significantly distally, so that the inner diameter of the detachment tube in the corresponding sections can be small; For example, it is possible that the release tube has a smaller inner diameter in the middle section than the diameter of the insertion wire in the proximal section.
• the insertion wire can also extend through the actual, intended for replacement implant.
• the insertion wire may extend distally beyond the distal end of the implant when the implant is in the compressed state.
• the insertion wire tip is located more distal than the distal end of the implant if it has not yet been released from the retaining element. In this way, even after the release of the implant, an object still first passes through the interior of the implant, as long as the insertion wire is not retracted. This makes it possible to re-probe the vessel or implant, for example by guiding a catheter over the insertion wire and the adjoining insertion wire tip. The catheter is thus moved through the released and expanded implant. The insertion wire tip is removed only by the final retraction of the insertion wire.
• the insertion wire tip can have a rotationally symmetrical design.
• the cross section may be round, oval, rectangular or basically any other type. It makes sense, moreover, to make the Ein Industriesdrahtspitze visualizable, z. B. by the insertion wire tip itself is at least partially made of a radiopaque material and / or in that the insertion wire tip has a radiopaque marker at its distal end.
• the insertion wire tip can be made of stainless steel, Nitinol, Platinum, Platinum / Iridium, Platinum / Tungsten or other metals.
• the insertion wire tip and the actual insertion wire can be made in one piece, ie it is ultimately a continuous wire. It is also possible, however, to manufacture the insertion wire tip and the insertion wire separately and to subsequently connect them together. In this case, the advantageous properties of different materials can be combined with each other, for example.
• the actual insertion of stainless steel with good Vorschieb sadness, the insertion wire tip consist of a nickel-titanium alloy such as nitinol to increase the flexibility. In this case, the manufacture of the nickel-titanium alloy does not have to be limited to the insertion wire tip itself, but may altogether affect the distal section of the insertion wire.
• the insertion wire can thus have a proximal and a distal portion, wherein, for example, the proximal portion of stainless steel, the distal portion is made of a nickel-titanium alloy.
• the transition between the proximal and distal sections is typically approximately where, in the first embodiment of the invention, the holding element is arranged.
• a distal section of nickel-titanium alloy also has the advantage of minimizing the risk of kinking, while on the other hand, the use of a more rigid material such as stainless steel is advantageous for the proximal portion of the insertion wire because this allows the transmission of torques, which is advantageous for the Vorschieb sadness.
• the invention also relates to an insertion wire having a proximal section and a distal section, wherein the distal section is made of a nickel-titanium alloy, preferably nitinol , while the proximal portion is made of a stiffer material, ie made of a material with a higher modulus of elasticity (Young's modulus).
• the material for the proximal portion may be stainless steel, but may also be a Co-Ni-Cr-Mo alloy such as MP35N, MP35NLT or Elgiloy.
• insertion wire is to be understood broadly and does not necessarily mean a classic wire in each case. Also conceivable, for example, elongated insertion aids with an inner cavity. In this case, the diameter of the insertion wire discussed above corresponds to the outer diameter. However, it is important that the insertion wire extends proximally so far that the attending physician can grasp and move the insertion wire.
• the detachable implant itself preferably has a wall of individual, intersecting filaments forming a tubular braid.
• the tubular braid is usually a round braid and has a circular cross section viewed from the proximal or distal end. In principle, however, deviations from the circular shape are possible, for example, an oval cross-section.
• the filaments constituting the mesh structure may be single metal wires, but it is also possible to provide strands, ie, a plurality of small diameter wires which together form a filament and are preferably twisted together.
• the implant is described by means of a flow diverter which is suitable for influencing the blood flow in a vessel in such a way that arteriovenous malformations as far as possible are shunted off from the blood flow.
• the malformations are mostly aneurysms.
• the device according to the invention is, however, not limited thereto and in principle also suitable for other implants which are intended to be introduced into blood vessels and to be detached there, for example conventional stents which are to perform a support function.
• the implant can also serve to occlude vessels that are to be decoupled from the bloodstream, for example by supplying tumors.
• the implant should be able to adapt to the respective vessel diameter. In the area of extensions and Aussackept it should assume at most its nominal diameter, d. H. the diameter that the implant takes without exerting external force.
• the implant As a material for the implant in particular materials with high restoring force or spring action come into question. These are in particular materials with superelastic or shape memory properties, for example nitinol.
• wires with different diameters can be used for the individual filaments.
• the advantages and disadvantages of wires with different cross sections can be combined or compensated in this way.
• the cross section of the wires is in most cases round, but are also possible wires with an oval or square cross section or combinations thereof. It is important in any case that the implant on the one hand is able, a compressed form for the purpose of passing through the microcatheter On the other hand, however, automatically expand on release from the external constraint of the microcatheter and on the implantation site to the vessel inner wall on the other hand.
• the implant from composite materials, for example platinum-clad nickel-titanium wires or nickel-titanium-coated platinum wires.
• the shape memory properties of the nickel-titanium alloy Niinol are combined with the radiopacity of the platinum.
• the diameter of the implant in the expanded state is typically between 2.5 and 5.0 mm.
• the length is, for example, 20 to 40 mm.
• the insertion wire may be made of stainless steel or else of a shape memory material, in particular of a nickel-titanium alloy, such as nitinol.
• a shape memory material in particular of a nickel-titanium alloy, such as nitinol.
• a stainless steel insertion wire with a nickel-titanium alloy tip at the distal end, or more generally distal portions of the nickel-titanium alloy introducer wire, and regions of a higher-grade material further proximal Modulus of elasticity to produce such as stainless steel.
• the implant serves as a flow diverter, it does not necessarily have a supportive function, as is the case with common stents. Rather, the implant serves primarily to channel the blood flow in the area of the malformations in the sense of a kind of inner cuff. For example, it should also prevent occlusion means placed in an aneurysm from being flushed out into the vascular pathway. In addition, the inflow and / or outflow of blood into an aneurysm can be prevented.
• the implants are typically fabricated as a braid of a plurality of filaments, the braid forming in principle an endless tube. The required implant length can then be cut to length from this endless tube.
• the individual filaments are wound in a spiral or helical shape, wherein the individual filaments are introduced as interlacing, that is, intersecting with each other and one above the other.
• the individual filaments are wound in two directions crossing each other at a constant angle, which intersect, for example, at an angle of 90 °.
• Preference is given - in the stress-free normal state - angles of more than 90 °, in particular from 90 to 1 60 °, wherein the open towards the axial ends of the implant angles are meant.
• Such a steep winding of the single filaments if sufficiently dense, can result in a high surface area mesh that can be pulled apart at axially elongated to significantly smaller diameters.
• the braid In the absence of stretching forces and sufficient restoring force of the filament material, the braid approaches the nominal diameter, ie the originally tension-free state, again and expands, resulting in a close fitting to the vessel wall at the implantation site and to a densification of the mesh structure on the wall. This is especially true in the field of vascular dilation.
• the surface coverage is thus higher in the areas of a vascular dilatation, such as an aneurysm, than in adjacent areas of the vessel.
• the surface coverage of the braid may also be varied by the braiding technique used. For example, the implant in the middle region, in which the aneurysm is typically covered, be more tightly braided than in the end regions, so that an extensive coverage of the Aneurysmahalses is guaranteed.
• a lower surface density in the end regions ensures sufficient flexibility.
• Vascular branches can be considered in the implants, for example, by areas of a lower mesh density.
• the thickness of the filaments is typically 0.01 to 0.2 mm, in particular 0.02 to 0.05 mm.
• Each individual filament can consist of a single wire or else of a strand of several bundled and preferably twisted individual wires.
• the individual wires can have the same diameter as well as different diameters.
• the wires can be made of different materials (nitinol, Cobalt-chromium alloys, platinum alloys). Wires made of a radiopaque material, for example, provide the radiopacity of the implant.
• filament ends can be brought together at least in pairs and permanently connected to each other at the implant ends. This can be done for example by welding, but also by mechanical stapling, twisting, soldering or gluing.
• a compound of the filament ends can also be done by means of an attached sleeve. This sleeve can enter into a cohesive connection with the filament ends, for example, be welded or crimped.
• the sleeve is dimensioned so that thickenings located at the filament ends are prevented from slipping through the sleeve. The sleeve is thus displaceable relative to the filaments in the axial direction, but it can not be completely removed.
• the sleeves can be offset from each other in the axial direction. In this way it is achieved that the sleeves do not come to rest directly on each other when compressing the implant, so that the implant has a smaller overall diameter.
• the connected filament ends can be atraumatically reshaped.
• the filament ends distally and / or proximally may have an atraumatic thickening, the z. B. is approximately spherical.
• Thickening can be achieved by laser welding, brazing, Gluing, crimping or the like formed from the end of the filament or attached to the end of the filament.
• the implant and possibly also the insertion wire should have a radiopaque marker material, if it is not made of a radiopaque material itself.
• radiopaque materials are in particular tantalum, gold, tungsten and platinum metals, in particular platinum alloys such as platinum-iridium or platinum-tungsten.
• These markers can be attached, for example, as marker elements in a known manner to the filament ends, but also be woven into the braid structure of the implant as marker filaments.
• the sheathing of individual filaments with a helix or wire of a radiopaque material such as platinum is also possible.
• the helix or the wire can be welded to the filaments, glued or the like. Another possibility is to coat or fill the filaments with a radiopaque material.
• radiopaque markers in the form of shells surrounding the merged filaments. These sleeves can be welded or crimped to the filament ends.
• the radiopaque sleeves can be identical to the above-mentioned sleeves for holding the ends of the filaments and thus fulfill a dual function.
• radiopaque substances into the detachment tube.
• These may be X-ray-visible particles, as commonly used in X-ray technology as a contrast agent.
• radiopaque substances are, for example, heavy metal salts such as barium sulfate or iodine compounds.
• the radiopacity of the detachable tube is helpful in the placement and localization of the implant, and may be used in addition to or instead of marker elements.
• the mesh can be coated with a film, for example made of Teflon, silicone or other biocompatible plastic.
• a film for example made of Teflon, silicone or other biocompatible plastic.
• such a plastic film can be slit, wherein the slot arrangement is staggered and the longitudinal direction of the slots runs along the circumferential line of the implant.
• Such a film can be achieved for example by immersing the implant in a corresponding liquid film material (dispersion or solution) and then inserting the slots, for example with a laser.
• a complete or partial filling of the mesh can be achieved.
• the implant may be coated in a manner known per se. Suitable coating materials are, in particular, those which are described for stents, for example antiproliferative, antiinflammatory, antithrombogenic, hemoglobin-promoting, and / or adhesion-inhibiting properties. Preferred is a coating that promotes implant ingrowth and neointima formation.
• the implant may be useful to coat the implant externally in such a way and inside with a means that reduces the attachment, such as heparin or a derivative, aspirin or suitable oligosaccharides and chitin derivatives.
• a means that reduces the attachment such as heparin or a derivative, aspirin or suitable oligosaccharides and chitin derivatives.
• layers of nano-particles such as ultrathin layers of polymeric S1O2, which reduce the adhesion.
• the invention also relates to a device which, in addition to the implant, the detachment tube and the insertion wire, also comprises a microcatheter through which the further components can be brought to the destination.
• the device may comprise a bearing sleeve in which the implant and possibly detachment tube and insertion wire can be stored for storage. In use, the implant is pushed out of the bearing sleeve into the microcatheter with the help of the insertion wire, typically using a conical transition piece.
• Figure 1 a, b A device with distal
• Figure 2a, b a device without distal
• Figure 4 a holding element in longitudinal section with fixed implant according to the first embodiment of the invention
• Figure 5 a device according to the invention in
• Figure 12 a variant of the second
• FIG. 1 a shows the basic structure of the device according to the invention according to the first embodiment of the invention, wherein the specific properties of the retaining element can not be seen in this illustration.
• the device is composed of an implant 1, an insertion wire 14 and a detachment tube 13.
• the implant 1 consists of a mesh in which individual wires 4 of a radiopaque material are interwoven, in order to ensure the radiopacity of the implant 1.
• the implant 1 is coupled to the insertion wire 14, which has a retaining element not shown in detail here.
• the retaining wires extending from the proximal end of the implant 1 are fixed in the retaining element, the detaching tube 13 preventing the retaining wires from coming off the retaining element.
• the insertion wire 14 extends distally through the implant 1 and has an insertion wire tip 9 at the distal end.
• the implant 1 is advanced through a microcatheter 8. At the proximal end insertion wire 14 and detachment tube 13 are held together by a Torquer 7.
• FIG. 1 b shows the implant 1 from FIG. 1 a in the detached state.
• the detachment tube 13 was withdrawn so that the holding wires could be released from the holding member of the insertion wire 14. Furthermore, the insertion wire tip 9 still passes through the implant 1, but can be withdrawn together with the insertion wire 14 and detachment tube 13.
• FIGS. 2 a and 2 b show an embodiment which corresponds in principle to that of FIGS. 1 a and 1 b, but here a distal insertion wire tip 9 has been omitted.
• the holding element 2 is shown in cross section.
• the holding element 2 is basically constructed substantially cylindrical and thus rotationally symmetrical.
• a number of grooves 3 is inserted, wherein the number of grooves 3 according to the example chosen here is four.
• the grooves 3 are open, so that the insertion of a holding wire 5 is possible.
• FIG. 3b is a longitudinal section through the retaining element 2.
• the holding element 2 is attached to the insertion wire 14.
• the grooves 3 have a wave-shaped course, the retaining wires 5 can be inserted accordingly so that a sufficiently strong frictional engagement takes place, which prevents withdrawal of the implant 1 in the longitudinal direction.
• the grooves 3 are open, so that a radial outlet of the retaining wires 5 is possible without problems as soon as a detaching hose 13 pulled over the retaining element 2 and the retaining wires 5 has been removed.
• the grooves 3 located on the edge of the retaining element 2 are only indicated in FIG. 3b, but, like the other grooves 3, have a wave-shaped course.
• FIG. 4 The overall principle of detachment is further clarified in Figure 4, in which the proximal implant end 12 is shown.
• the implant 1 is composed of a multiplicity of braided wires 6. Of the braided wires 6, some braided wires 6 have an extended proximal end, the extension giving the retaining wire 5 inserted in a groove 3. The number of retaining wires 5 usually corresponds to the number of grooves 3.
• the wave-shaped course of the groove 3 and the retaining wire 5 is a corresponding waveform impressed, whereby the retaining wire 5 by means Friction is held in the groove 3.
• the stiffness of the retaining wire 5 is to be matched to the device that an unwanted withdrawal of the retaining wire 5 is practically excluded from the groove 3 at typically occurring in the context of implanting shear or tensile forces.
• each 2nd, 4th or 8th braid wire 6 is made longer so that a retaining wire 5 results.
• Some braided wires 6 also have a platinum coil 10, which serves to increase the radiopacity of the implant 1.
• the detachment tube 13 is pulled over both the retaining element 2 and via the proximal implant end 12. In this way, on the one hand it is ensured that release of the implant 1 can not take place before the detachment tube 13 is pulled down by the holding element 2 until all of the grooves 3 are exposed. On the other hand, the fact that the detachment tube 13 is also pulled over the proximal implant end 12 ensures that even after the implant has been released from the microcatheter, the braid wires 6 are held together at the proximal end 12 and retraction into the microcatheter 8 is still possible if required is as long as the detachment tube 13 has not been withdrawn.
• the detachment tube 13 has at its distal end one or more pads 1 1, which are made of an elastic material and produce a sufficiently high frictional engagement between Päd 1 1 and implant 1, so that advancing and retracting the implant 1 by movement of the detachment tube thirteenth is possible.
• the implant 1 is located in the representation selected here within the microcatheter 8, ie in its compressed form.
• the insertion wire 14 here extends through the entire implant so that the insertion wire tip 9 is distal to the distal end of the implant, but an insertion wire tip 9 is not mandatory.
• FIGS. 3 a, 3 b and 4 in the illustration according to FIGS.
• the detaching principle is thus based on detachment by widening the implant 1 in the radial direction, while producing sufficiently high frictional forces in the axial direction which preclude release of the implant 1 in the axial direction.
• FIGS. 6-11 show different variants of detachment tubes 13.
• a proximal portion 15 of the detachment tube 13 has a higher, a more distal lying central portion 1 6, however, a lower cross section.
• the middle section 16 of the detachable tube 13 is quite flexible and can be easily advanced during transport through narrow-bore blood vessels; on the other side, the detachable tube 13 can also be withdrawn proximally without any problems since the proximal section 15 has a higher cross section and thus limits the longitudinal extensibility of the release tube 13.
• the pedestal 1 1 is made of the tubing itself d. H. There is no Päd 1 1 additionally attached to the release hose 13.
• Figure 7 illustrates a similar embodiment, in which also the middle portion 1 6 has a lower cross-section than the proximal portion 15 of the release tube 13. In contrast to the embodiment shown in Figure 6, however, two pads 1 1 are attached separately here, the release tube 13 surrounded in a ring.
• FIG. 8 shows a further variant in which the proximal section 15 likewise has a higher cross-section than the more distal central section 16 of the detachable tube 13, but here only one pedestal 11 which surrounds the detachment tube 13 in a ring shape has been applied, which is longer is formed as the individual pads according to FIG. 7 Figures 9, 10 and 11 correspond to Figures 6, 7 and 8, but with the release tube 13 having no heel and, apart from the distal end, having a uniform cross-section.
• FIG. 12 illustrates a variant in which a frictional connection between implant 1 and detachment tube 13 is produced by wrapping a detachment wire 17 around the implant 1.
• the detaching wire 1 7 laces the implant 1 between two pads 1 1 so far that a fixation of the implant 1 is given on the detachment tube 13.
• the implant 1 thus remains fixed on the detachable tube 13 until electrolytic corrosion of the detaching wire 17 takes place at a detachment point provided for this purpose by applying an electrical voltage and the detaching wire is detached from the implant 1.
• the implant 1 can expand and the microcatheter, the detachment tube 13, the insertion wire 14 and the remaining ends of the stripping wire 17 are withdrawn.
• the two ends of the stripping wire 17 extend proximally.

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• Health & Medical Sciences (AREA)
• Engineering & Computer Science (AREA)
• Biomedical Technology (AREA)
• Cardiology (AREA)
• Transplantation (AREA)
• Vascular Medicine (AREA)
• Public Health (AREA)
• Heart & Thoracic Surgery (AREA)
• Veterinary Medicine (AREA)
• Life Sciences & Earth Sciences (AREA)
• Animal Behavior & Ethology (AREA)
• General Health & Medical Sciences (AREA)
• Oral & Maxillofacial Surgery (AREA)
• Orthopedic Medicine & Surgery (AREA)
• Mechanical Engineering (AREA)
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• Urology & Nephrology (AREA)
• Prostheses (AREA)
• Media Introduction/Drainage Providing Device (AREA)

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